Permit .71 CITY OF TIGARD PLUMBING PERMIT
C COMMUNITY DEVELOPMENT Permit #: PLM2010 -00313
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/23/2010
Parcel: 2S103CB00100
Jurisdiction: Tigard
Site address: 13035 SW 121ST AVE
Subdivision: WILLAMETTE Lot: 1
Project: Lancaster
Project Description: Installation of sanitary sewer line, decomission septic tank and connect to public sewer.
Owner: FEES
LANCASTER, MICHAEL T AND PATRICIA Quantity Description Date Amount
13035 SW 121ST AVE
TIGARD, OR 97223 100 If Sewer Service 09/23/2010 $62.54
PHONE: 503 - 322 -6727 1 12% State Surcharge - 09/23/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 09/23/2010 $9.96
Contractor: Plumbing
THE EXCAVATORS LLC
PO BOX 690
YAMHILL, OR 97148
PHONE: 503 - 708 -2706
FAX: 503 - 662 -3513
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: A lQ I Permittee Signature: • L.._' '
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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E P 2 3 111rIWOITcrateivey: j City of Tigard Permit No. �w a.
Ii V 13125 SW Hall Blvd., Tigard, OR 972 20 p o' 13 / d � /a /® ,,,
Plan Review
C Permit °
Phone: 503.639.4171 Fax: 503.598.1960 Other No,rl42 /fj ,s'
Inspection Line: 503.639.4175 CITY OF TIGARD Date/By:
f I i r\ I:1) Date Ready/By: See Page 2 for
Internet: www.tigard or.gov gull DING DIVISION 1 : N Notified/Method: .1.176....1
Supplementallnformii800
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist:
Description I Qty. I Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
. CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 1 3 O3 S Sc... l 21 5 Catch basin or area drain 18.76
� (1 2 �' 1, leach line, or trench drain 18.76
Ci ty �� /State /ZIP: U C 1 c 7 r
Footing Footing drain (no. linear ft.:. ) Page 2
Suite/bldg. /apt. no.: i Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
(/ �l --fr r , ` a , / • ' Rain drain connector 18.76
Sanitary sewer (no. linear ft.4 O) Page 2 60 2. Sy
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
I_ Clothes washer 25.02
.cr\ .f4 ( e<A, 6,- 5G 0- 46 Sc1) _ c Dishwasher 25.02
t- ( t' L, Q ,L( ^ (x' S '{CG 1r\( Drinking fountain 25.02
Ejectors /sump 25.02
1 1RSOPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: (c 4 tom C Gee. . e4 5 (I-, \C' Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: (''- 5 S -9� 1 Zl Garbage disposal 25.02
City/State /ZIP: e1 q _ Hose bib 25.02
,„
Phone: q ) () 59. - 7 2..7 � � Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
L Water heater 37.52
Business name: e x C Q(J o" J L Water piping/DWV 56.29
Address: FQ OK (g q0 Other: ' 25.02
City /State /ZIP: yam 1141 i✓"C q7/Lie Subtotal G 2 , sY
Phone: (5O1) 70/3 - ,. (/ Fax: (ap3) 67&;- 3s/3 Minimum permit fee: $72.50 f,? sa
ft4.-CCB Lic.: / S 3 3 7 .24 ' lumbing Lic. no.: 110 Plan review (25% of permit fee)
3
�' , State surcharge (12 %ofpermit fee) - P.20
Authorized signature: ' .. 4411 0 TOTAL PERMIT FEE ,P/ .20
Print name: R (7 ! - Da te: Q This permit application expires if a permit is not obtained within 180 days
t ► after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
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2A / � /6 7, 7/
Plumbing Permit Application - City of Tigard Jul'
Page 2 - Supplemental Information
a1r e Residential Fire Suppression Systems:
• - to f�ities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footingdrain - 1' 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer - 1st 100' 1 62.54 ( 2.5y Y 7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Storm &Rain Drain - 1st 100' 62.54 Valuation: Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
p and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to
(minimum charge - 1/2 hour) and including $25,000.00.
Inspections outside ofnorrnal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to
Reinspection Fees 90.00/hr and including $50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
(minimum charge - 1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work: .
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
-Tub/Shower as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ Any mufttpurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
3 that meet the qualifications above.
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
. - Industrial Comments regarding fixture work:
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be aid before the
Washer - Clothes p
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
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